Emily Conradi

Virtual patients in a virtual world: Training paramedic students for practice

Collaborative learning through case-based or problem-based learning (PBL) scenarios is an excellent way for students to acquire knowledge and develop decision-making skills. However, the process is threatened by the movement towards more self-directed learning and the migration of students from campus-based to workplace-based learning. Paper-based PBL cases can only proceed in a single direction which can prevent learners from exploring the impact of their decisions. The PREVIEW project, outlined in this article, trialled a replacement to traditional paper PBL with virtual patients (VPs) delivered through a virtual world platform. The idea was that an immersive 3D environment could provide (a) greater realism (b) active decision-making and (c) a suitable environment for collaboration amongst work-based learners meeting remotely. Five VP scenarios were designed for learners on a Paramedic Foundation Degree within the virtual world second life (SL). A player using the MedBiquitous VP international standard allowed cases to be played both within SL and on the web. Three testing days were run to evaluate the scenarios with paramedic students and tutors. Students unfamiliar with the SL environment worked through five PBL scenarios in small groups, shadowed by ‘in-world’ facilitators. Feedback indicated that the SL environment engages students effectively in learning, despite some technology barriers. Students believed SL could provide a more authentic learner environment than classroom-based PBL.

The replacement of 'paper' cases by interactive online virtual patients in problem-based learning

St Georges University of London (SGUL) has a Problem-Based Learning (PBL) curriculum for its undergraduate medicine course, using traditional paper-based patient cases. To counter the limitation that paper cases are linear and do not allow students to explore the consequences of decisions, interactive online virtual patients (VPs) were developed which allowed students to consider options as the cases unfold, and allow students to explore the consequences of their actions. A PBL module was converted to VPs, and delivered to 72 students in 10 tutorial groups, with 5 groups each week receiving VPs with options and consequences, and 5 groups receiving online VPs but without options. A comprehensive evaluation was carried out, using questionnaires, and interviews.Both tutors and students believed that the ability to explore options and consequences created a more engaging experience and encouraged students to explore their learning. They regretted the loss of paper and neither group could see any value in putting cases online without the options. SGUL is now adapting its transitional year between the early campus years and the clinical attachment years. This will include the integration of all technology-based resources with face-to-face learning and create a more adaptive, personalised, competency-based style of learning.

Training staff to create simple interactive virtual patients: the impact on a medical and healthcare institution

Background: Virtual patients (VPs) are excellent teaching tools for developing clinical decision-making skills and improving clinical competency, but are believed to be very expensive and time consuming to make. Aim: The aim of this study was to establish whether it was possible to design a workshop for VP creation, which would enable teaching staff to create interactive, immersive VPs quickly, and with limited technical support. Methods: The Centre for Medical and Healthcare Education at St Georges University of Londons (SGUL) medical school developed an ergonomic and generic ‘model’ for VP creation, simple enough for clinicians and educators to use, yet flexible enough to simulate real decisions through non-linear pathways. One-day workshops were set up to support the development of VPs by medical and healthcare educators. Results: VP creation workshops have been successfully trialled, attracting a large number of clinicians and educators from a range of medicine and healthcare courses. Feedback from participants was very positive. Educators, organised into small groups, were unable to complete VPs within the workshop, but many groups completed a VP after the workshop. Interest was highest in mental health. Discussion: The workshops catalysed a change in the awareness of the value of VPs, with staff directly integrating VPs into the curriculum.

Improving assessment with virtual patients

Assessments should accurately predict future performance in a wide variety of settings yet be feasible to conduct. In medical education a robust and comprehensive system of assessment is essential to protect the public from inadequate professionals. The parameters for devising such an assessment are well-defined, and good practice for writing examinations well-established. However even excellent written assessments are limited in their predictive validity, and limited in sampling, face and construct validity. The increasing availability and power of computing has led to growing interest in computer simulations for use in examinations, creating assessment virtual patients (AVPs). They can potentially test knowledge and data interpretation, incorporate images, sound or video and test decision making. Such AVPs could represent the most comprehensive, integrated assessment possible that is both objective and feasible. This article focuses on AVP design, distinguishing between linear and branched models, choice and consequence driven designs. It reviews the use of AVPs in the context of assessment theory. It presents different AVP designs discussing their benefits and problems. AVPs can become valuable components in high stakes medical exams, particularly in later years of courses. However this requires application of established assessment principles to AVP design.

Evaluating a Second Life Problem-Based Learning (PBL) demonstrator project: what can we learn?

This article reports the findings of a demonstrator project to evaluate how effectively Immersive Virtual Worlds (IVWs) could support problem-based learning. The project designed, created and evaluated eight scenarios within Second Life (SL) for undergraduate courses in health care management and paramedic training. Evaluation was primarily qualitative, using illuminative evaluation which provided multiple perspectives through interviews, focus groups and questionnaires with designers, facilitators, learning technologists and students. Results showed that SL provided a rich, engaging environment which enhanced authenticity of the scenarios, though there were issues of access and usability. The article concludes by drawing together the lessons learned which will inform educators who seek to design and develop learning scenarios in this medium.

Development, implementation and initial evaluation of narrative virtual patients for use in vocational mental health nurse training

Simulation techniques such as virtual patients (VPs) are valuable tools for teaching and learning a range of clinical proficiencies. Compared with other forms of simulation, however, the reported use of VPs within nursing is limited. Descriptions of simple, low cost methods for the development of VP devices could help facilitate their wider implementation and use in nursing education and training. In order to encourage broader use of VP technologies within nursing, this paper aims to expand current knowledge of VP creation by reference to the development of two virtual mental health patients produced for a multilingual e-learning course for European mental health nurses. Focusing on narrative VPs, the paper provides a brief overview of various types and potential uses of VP techniques, along with central elements of good practice in VP development. The five phase development framework used in the creation of the two VPs is presented. Processes detailed include the design and construction of case scenarios and multimedia components, in addition to initial usability and validity testing. VPs like those described here are a relatively inexpensive way of integrating virtual simulation technology into nursing education, particularly within online, blended and/or cross-cultural learning environments.